Endocarditis physical examination: Difference between revisions

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{{Endocarditis}}
{{Endocarditis}}


{{CMG}}; '''Associate Editors-in-Chief:''' {{CZ}}
{{CMG}}; {{AE}} {{CZ}}


==Overview==
==Overview==
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===Heart===
===Heart===
*Heart [[murmur]]s are present in 80% to 85% of patients including that of [[aortic insufficiency]], [[tricuspid regurgitation]] and [[mitral regurgitation]].
*Heart [[murmur]]s are present in 80% to 85% of patients including that of [[aortic insufficiency]], [[tricuspid regurgitation]] and [[mitral regurgitation]].<ref name="pmid96368522">{{cite journal| author=John MD, Hibberd PL, Karchmer AW, Sleeper LA, Calderwood SB| title=Staphylococcus aureus prosthetic valve endocarditis: optimal management and risk factors for death. | journal=Clin Infect Dis | year= 1998 | volume= 26 | issue= 6 | pages= 1302-9 | pmid=9636852 | doi=10.1086/516378 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9636852  }}</ref>


===Abdomen===
===Abdomen===
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===Back===
===Back===


* Back examination of patients with endocarditis is usually normal
* Back examination of patients with [[endocarditis]] is usually normal


===Genitourinary===
===Genitourinary===


* Genitourinary examination of patients with endocarditis is usually normal.
* Genitourinary examination of patients with [[endocarditis]] is usually normal.


===Neurologic===
===Neurologic===


*[[Septic emboli]] may result in [[stroke]] and focal neurologic findings
*[[Septic emboli]] may result in [[stroke]] and focal [[neurologic]] findings<ref name="pmid9636852">{{cite journal| author=John MD, Hibberd PL, Karchmer AW, Sleeper LA, Calderwood SB| title=Staphylococcus aureus prosthetic valve endocarditis: optimal management and risk factors for death. | journal=Clin Infect Dis | year= 1998 | volume= 26 | issue= 6 | pages= 1302-9 | pmid=9636852 | doi=10.1086/516378 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9636852  }}</ref>
*[[Seizures]] may be present
*[[Seizures]] may be present
*[[Intracranial hemorrhage]] may occur
*[[Intracranial hemorrhage]] may occur
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===Extremities===
===Extremities===
* [[Janeway lesion]]s (painless hemorrhagic cutaneous lesions on the palms and soles)
* [[Janeway lesion]]s (painless [[hemorrhagic]] cutaneous lesions on the palms and soles)
* [[Gangrene]] of fingers may occur
* [[Gangrene]] of fingers may occur
* The fingers may show [[splinter haemorrhage]]s
* The fingers may show [[splinter haemorrhage]]s

Latest revision as of 14:26, 4 March 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Common signs on physical examination of endocarditis include fever, presence of a new or changing heart murmur, rigors, Osler's nodes, Janeway lesions and evidence of embolization. Aortic insufficiency with a wide pulse pressure, mitral regurgitation or tricuspid regurgitation may be present depending upon the valve that is infected.

Physical Examination

Appearance of the Patient

Vital Signs

Skin

Petechiae
Splinter hemorrhages
Osler's nodes
Janeway lesions

Oral Cavity

Examine the oral cavity:

HEENT


Roth's spots (white centered hemorrhage)







Neck

  • Neck examination of patients with endocarditis is usually normal.

Lungs

Heart

Abdomen

Back

  • Back examination of patients with endocarditis is usually normal

Genitourinary

  • Genitourinary examination of patients with endocarditis is usually normal.

Neurologic

Extremities


References

  1. Baddour, LM.; Wilson, WR.; Bayer, AS.; Fowler, VG.; Bolger, AF.; Levison, ME.; Ferrieri, P.; Gerber, MA.; Tani, LY. (2005). "Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145. Unknown parameter |month= ignored (help)
  2. Lockhart PB, Brennan MT, Thornhill M, Michalowicz BS, Noll J, Bahrani-Mougeot FK; et al. (2009). "Poor oral hygiene as a risk factor for infective endocarditis-related bacteremia". J Am Dent Assoc. 140 (10): 1238–44. PMC 2770162. PMID 19797553.
  3. John MD, Hibberd PL, Karchmer AW, Sleeper LA, Calderwood SB (1998). "Staphylococcus aureus prosthetic valve endocarditis: optimal management and risk factors for death". Clin Infect Dis. 26 (6): 1302–9. doi:10.1086/516378. PMID 9636852.
  4. John MD, Hibberd PL, Karchmer AW, Sleeper LA, Calderwood SB (1998). "Staphylococcus aureus prosthetic valve endocarditis: optimal management and risk factors for death". Clin Infect Dis. 26 (6): 1302–9. doi:10.1086/516378. PMID 9636852.


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